Kathy Neuzil

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Dr. Kathy Neuzil
Program Leader Vaccine Access and Delivery, PATH

Wednesday

15 January

2014

Rotavirus vaccine introduced in Mali

Dr. Kathy Neuzil, Program Leader Vaccine Access and Delivery, PATH, is in Mali this week as the country introduces a vaccine against rotavirus, the most common cause of severe and fatal diarrhea in young children worldwide. Her report follows.

Credit: UNICEF Mali/2014/Cao.

As I watched the historic launch of rotavirus vaccines in Bamako, Mali, yesterday, I was reminded of an anxious time in my life more than a decade ago. I sat between two small beds in a hospital room in Seattle, Washington USA, where my daughter, 1, and my son, 6, were both receiving intravenous (IV) fluid for serious diarrhea. As a physician, I knew that rehydration with IV fluids is a simple and potentially lifesaving intervention. As a mother, I was worried.

Fortunately, my children were able to return home with me the following day, fully recovered. I was grateful that the hospital was an easy 15-minute drive from my home, and that advanced medical care was readily available.

Had I been a mother in Mali, I may not have been so fortunate—one or both of my children could have died from diarrhea. Mali is one of the poorest countries in the world. Mothers, fathers, and other caregivers often have to travel great distances over difficult terrain to reach health facilities. Depending on the location, IV therapy may not be available for their children. Lack of access to care is one reason more than 90 percent of diarrhea-related deaths occur in young children in countries with few resources.

Protecting against life-threatening diarrhea

Rotavirus is the most common cause of severe and fatal diarrhea in young children worldwide. In Mali, it kills more than 7,200 children each year and hospitalizes many more. Vaccination against rotavirus as part of a comprehensive approach to prevent and control diarrheal disease is the best way to protect infants from rotavirus disease and reduce its burden. In many countries that have introduced rotavirus vaccines, scientific studies have shown swift and significant declines in hospitalization and deaths due to diarrhea, as these tables on our rotavirus vaccine access and delivery website show.

While this is not my first visit to Mali, it is certainly my most gratifying. Yesterday’s momentous occasion is the culmination of more than seven years of hard work by a dedicated Malian team, my colleagues at PATH, and many other partners who paved the way for distribution of these lifesaving vaccines in Mali and in other low-resource countries.

Expanding access to a potential lifesaver

Credit: UNICEF Mali/2014/Cao.

In 2005, I joined PATH’s Rotavirus Vaccine Program, a partnership with the World Health Organization (WHO) and the US Centers for Disease Control and Prevention that was funded by the GAVI Alliance. We worked with rotavirus vaccine manufacturers and in-country partners to design and execute clinical trials of rotavirus vaccines in Africa and Asia, including here in Mali. The strong evidence generated from these trials was pivotal to the 2009 WHO recommendation that all countries introduce rotavirus vaccines into their childhood immunization programs.

Mali is the 20th GAVI-eligible country and the 53rd worldwide to introduce rotavirus vaccines into its national immunization program. While this is cause for celebration, there is a lot more work to be done. Many children still do not have access to the lifesaving benefits of rotavirus vaccines. While 14 countries—13 of them in Africa—plan to introduce rotavirus vaccines with GAVI support in the next two years, more than 15 other GAVI-eligible countries have yet to apply for rotavirus vaccine support. In addition, numerous middle-income countries, where childhood diarrhea is a huge problem, have yet to include rotavirus vaccines in their national immunization programs.

The incredible, positive health effects and related reduction in health costs due to the introduction of rotavirus vaccines is one of the most remarkable public health achievements of the past decade. Mali’s decision to proceed with rotavirus vaccine introduction despite recent devastating political and social turmoil underscores the country’s commitment to the health and lives of its children. Mali’s leadership should inspire other countries to take action in the fight against rotavirus and help ensure that all children worldwide have access to these lifesaving vaccines.